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suck abstract from ncbi


10.1016/j.ejim.2021.03.026

http://scihub22266oqcxt.onion/10.1016/j.ejim.2021.03.026
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33820686!7997723!33820686
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suck abstract from ncbi


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pmid33820686      Eur+J+Intern+Med 2021 ; 88 (ä): 52-62
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  • Lessons from pathophysiology: Use of individualized combination treatments with immune interventional agents to tackle severe respiratory failure in patients with COVID-19 #MMPMID33820686
  • Dalekos GN; Stefos A; Georgiadou S; Lygoura V; Michail A; Ntaios G; Samakidou A; Giannoulis G; Gabeta S; Vlychou M; Petinaki E; Leventogiannis K; Giamarellos-Bourboulis EJ; Gatselis NK
  • Eur J Intern Med 2021[Jun]; 88 (ä): 52-62 PMID33820686show ga
  • Aims Infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may lead to the development of severe respiratory failure. In hospitalized-patients, prompt interruption of the virus-driven inflammatory process by using combination treatments seems theoretically of outmost importance. Our aim was to investigate the hypothesis of multifaceted management of these patients. Methods A treatment algorithm based on ferritin was applied in 311 patients (67.2% males; median age 63-years; moderate disease, n=101; severe, n=210). Patients with ferritin <500ng/ml received anakinra 2-4mg/kg/day +/- corticosteroids (Arm A, n=142) while those with >/=500ng/ml received anakinra 5-8mg/kg/day with corticosteroids and gamma-globulins (Arm B, n=169). In case of no improvement a single dose of tocilizumab (8mg/kg; maximum 800mg) was administered with the potential of additional second and/or third pulses. Treatment endpoints were the rate of the development of respiratory failure necessitating intubation and the SARS-CoV-2-related mortality. The proposed algorithm was also validated in matched hospitalized-patients treated with standard-of-care during the same period. Results In overall, intubation and mortality rates were 5.8% and 5.1% (0% in moderate; 8.6% and 7.6% in severe). Low baseline pO(2)/FiO(2) and older age were independent risk factors. Comparators had significantly higher intubation (HR=7.4; 95%CI: 4.1-13.4; p<0.001) and death rates (HR=4.5, 95%CI: 2.1-9.4, p<0.001). Significant adverse events were rare, including severe secondary infections in only 7/311 (2.3%). Conclusions Early administration of personalized combinations of immunomodulatory agents may be life-saving in hospitalized-patients with COVID-19. An immediate intervention (the sooner the better) could be helpful to avoid development of full-blown acute respiratory distress syndrome and improve survival.
  • |*COVID-19[MESH]
  • |*Respiratory Distress Syndrome[MESH]
  • |*Respiratory Insufficiency/therapy[MESH]
  • |Aged[MESH]
  • |Female[MESH]
  • |Humans[MESH]
  • |Interleukin 1 Receptor Antagonist Protein[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |SARS-CoV-2[MESH]


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